Abstract Summary of Proposal ? This proposal outlines 5-year training and research program that will allow the investigator to achieve his goal of becoming an independent academic patient-oriented researcher. The Candidate will use his strong academic background, training and expertise in maternal health and women?s health to improve on care, screening, outcomes and follow-up of women with history of gestational diabetes and hypertensive disease in pregnancy by focusing on metabolic syndrome, a direct predictor of cardiovascular disease. As a masters student the candidate designed and conducted a successful clinical trial on male partner and couple HIV testing during pregnancy. He has also been a Fogarty scholar, and Fellow during which he served as a study coordinator in enrolling and following up participants for 2 years. The proposed program will build on the candidate?s extensive experience with clinical research in resource constrained settings by improving his skills in study design and epidemiologic analysis of longitudinal data and enhancing his understanding of metabolic syndrome, cardiovascular disease epidemiology, and the role of inflammatory markers in the disease process. The Candidate is a supported by excellent expert mentors in an outstanding institutional environment and a highly successful collaborative partnership between the University of Nairobi and the University of Washington. RESEARCH PLAN ?Cardiovascular disease (CVD) in sub- Saharan Africa is a growing burden, and predominantly affects younger people and women. Hypertensive disease in pregnancy (HDP) and gestational diabetes mellitus (GDM) increase the risk of future CVD more than two-fold. HDP, GDM and CVD are characterized metabolic syndrome (MetS), a cluster of factors that directly increase the risk of CVD suggesting a shared pathology, which can be targeted for screening, monitoring and intervention. In contrast to high-income countries that have guidelines on monitoring women after HDP and GDM, women in LMIC do not have access to these services or CVD prevention and instead present with established CVD. Compared to the rest of the world, CVD in sub-Saharan Africa is distinctively different in its inflammatory and not atherosclerotic etiology and women in sub-Saharan Africa may therefore have unique differences that influence the association between HDP and GDM, MetS and CVD. We propose to conduct a prospective cohort study to estimate the burden and characteristics of metabolic syndrome in Kenya, following HDP, and GDM using the following specific aims. Aim 1: Demonstrate that women with versus those without HDP and GDM are more likely to have MetS at 24 weeks post delivery. Aim 2: Among women without MetS at 24 weeks post-delivery, determine whether HDP and GDM is associated with increased diagnosis of MetS during 3 years of follow-up. Aim 3: Determine sociodemographic and biological correlates of women who are diagnosed with MetS compared to those without MetS at different time points from 24 to 36 months post delivery that may lead to improved screening and follow-up of women with HDP and GDM. Our study findings will inform use of high attendance of maternal health clinics in sub-Saharan Africa, where at least 1 in 10 women are diagnosed with hypertensive disease of pregnancy and gestational diabetes mellitus, as a window of opportunity for post delivery strategies to identify women with MetS for timely CVD prevention interventions. These findings may inform maternal health and primary care linkages, and development of screening and monitoring strategies of women with HDP, GDM, and MetS in resource-constrained settings.